Aldosterone is a bad actor. It is cardiotoxic. It drives a lot of hypertension. It is likely a progression factor in chronic kidney disease. (presentation with a lot of references to the primary data by Adrian Covic can be found here). This is why aldosterone antagonists are such effective drugs in heart failure, such good […]

Recently I have been tweeting back and forth with some biotech investors that have some strong feelings about patiromer. The recuring pro-patiromer theme is the drug will allow people to stay on their ACE inhibitor or angiotensin receptor blocker without fear of hyperkalemia. This is not a stretch belief by team patiromer, it was one […]

The deadline to apply for the nephrology social media internship is approaching. You have just until this Sunday to get your application in. We have been getting some questions about how much work there is and who the program is designed for.I’m a critical care doctor. Can I join the internship?I’m a nurse. Can I […]

Tonight there is a twitter chat on this article The chat is at 9:00 PM EST, with hashtag: #JHMChat. The paper is a good review of the weaknesses of both the fractional excretion of sodium and urea. I have a few critiques of the article but one in particular is too complex to express in […]

I teach IV fluids to every third year medical student and resident that crosses the threshold at St John Hospital. It’s what I do. It’s a conventional lecture focusing on the expected fluid distribution following various flavors of IV fluids. The dogma of IV fluids is that dextrose solutions, crystalloids and plasma expanders distribute across […]

The first second Nephrology Social Media Internship Told you we’d get a logo Last year we launched the social media internship with 4 interns. It went well and all of them had a unique and positive experience. They have all graduated from pupil to teacher and are part of the NSMC faculty. The remainder of the faculty remains […]

The SPLIT trial was the long awaited randomized control trial that pitted normal saline against the balanced solution du jour, Plasma Lyte-148. I have never before dedicated to the statistical plan for a study before the wait up to SPLIT: I wasn’t the only fluids nerd waiting for SPLIT. In the days and weeks after the study dropped […]

COI: I have an ownership stake in four Davita run dialysis clinics and one vascular access center. Astellas paid for my trip to Australia (Feb ’16) for me to speak at one meeting and three hospitals. Takeda Oncology made a donation to MM4MM the program that is taking me to Mount Everest in 2018.